Indication & Dosage

Indication:
For Local anaesthesia

Dosage and Administration:
USE IN LOCAL ANAESTHESIA
The dose of lidocaine hydrochloride used for local anaesthesia depends on the site of injection and the procedure used. Specific licensed doses for individual procedures are not always available in the UK, although US product information often includes them (see below). When given with adrenaline, the suggested general maximum single dose of lidocaine hydrochloride is 500 mg; without adrenaline, the recommended maximum single dose in the UK is 200 mg and in the USA, 300 mg, except for spinal anaesthesia (see below). Lidocaine hydrochloride solutions containing adrenaline 1 in 200 000 are used for infiltration anaesthesia and nerve blocks including epidural block; higher concentrations of adrenaline are seldom necessary, except in dentistry, where solutions of lidocaine hydrochloride with adrenaline 1 in 80 000 are widely used. Doses should be reduced in children, the elderly, and in debilitated patients. A test dose, preferably with adrenaline, should be given before starting epidural block to detect inadvertent intravascular or subarachnoid dosage. The following doses have been recommended for individual local anaesthetic procedures in the USA:

For percutaneous infiltration anaesthesia, 5 to 300 mg (1 to 60 mL of a 0.5% solution, or 0.5 to 30 mL of a 1% solution). The dosage in peripheral nerve block depends on the route. For brachial plexus block 225 to 300 mg (15 to 20 mL) as a 1.5% solution is used; for intercostal nerve block 30 mg (3 mL) is given as a 1% solution; for paracervical block a 1% solution is used in a dose of 100 mg (10 mL) on each side, repeated not more frequently than every 90 minutes; for paravertebral block a 1% solution may be used in doses of 30 to 50 mg (3 to 5 mL); a 1% solution is recommended for pudendal block in doses of 100 mg (10 mL) on each side; for retrobulbar block a 4% solution may be used in doses of 120 to 200 mg (3 to 5 mL).

For sympathetic nerve block a 1% solution is recommended; doses are 50 mg (5 mL) for cervical block and 50 to 100 mg (5 to 10 mL) for lumbar block.

For epidural anaesthesia 2 to 3 mL of solution is needed for each dermatome to be anaesthetised but usual total doses and recommended concentrations are: lumbar epidural 250 to 300 mg (25 to 30 mL) as a 1% solution for analgesia and 225 to 300 mg (15 to 20 mL) as a 1.5% solution or 200 to 300 mg (10 to 15 mL) as a 2% solution for anaesthesia, and for thoracic epidural a 1% solution may be used at doses of 200 to 300 mg (20 to 30 mL). In obstetric caudal analgesia up to 300 mg (30 mL) is used as a 0.5% or 1% solution and in surgical caudal analgesia a 1.5% solution may be used in doses of 225 to 300 mg (15 to 20 mL). For continuous epidural anaesthesia, the maximum doses should not be repeated more frequently than every 90 minutes.

A hyperbaric solution of 1.5% or 5% lidocaine hydrochloride in glucose 7.5% solution is available for spinal anaesthesia; adrenaline should not be used. Doses of up to 50 mg (1 mL) as a 5% solution and 9 to 15 mg (0.6 to 1 mL) as a 1.5% solution have been used during labour for a normal vaginal delivery. Up to 75 mg (1.5 mL) as the 5% solution has been used for caesarean section and 75 to 100 mg (1.5 to 2 mL) for other surgical procedures.

For intravenous regional anaesthesia a 0.5% solution without adrenaline has been used in doses of 50 to 300 mg (10 to 60 mL); a maximum dose of 4 mg/kg has been recommended for adults.